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As highlighted in recent series in The Lancet (2007, 2011), children from low and middle income countries are more likely to be adversely affected by early biological and psychosocial experiences that have their origins in environments characterized by poverty, violence, nutritional deficiencies, HIV infections, substance abuse, and inadequate learning opportunities. Due in part to discriminatory legacies of the past, these risks are all still highly prevalent in South Africa even after almost 20 years of democracy, creating a situation where a significant number of young children grow up at risk for developmental delay in comparison with those born with established risk. Thus, in a country where resources are scarce and where early intervention starts too late and ends too early for most children, it is vital that protective factors at various levels of the ecology be mobilized at the earliest opportunity to prevent the accumulation of risk factors as well as balance inequalities where risks are already established. Using Guralnick's developmental systems model as a framework, this article first reviews the current situation of young children in South Africa by focusing on policies, programs, and service provisioning that provide the impetus for early childhood intervention. On the basis of the model, its overarching framework, as well as typical case studies encountered in this context, the authors propose improvements toward a more cohesive and coordinated early intervention system in this country by highlighting efforts at advancing early screening and referral, interdisciplinary assessment, and family-focused community models of intervention.

Chris Hani Baragwanath Hospital, Soweto, South Africa (Dr Balton); Centre for Augmentative and Alternative Communication, University of Pretoria, Pretoria (Ms Samuels and Dr Balton); and Department of Paediatrics and Child Health, University of the Witwatersrand, Johannesburg (Ms Slemming), South Africa.